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To prevent breathing problems like asthma flares, few medications are more effective than an inhaled corticosteroid. As you draw the medication in through your mouth, it travels directly to your lungs to reduce inflammation and help you breathe more easily.

But more recent research, including a large study of 16,000 patients published this April in the American Journal of Respiratory and Critical Care Medicine, has found that corticosteroids may be less risky for COPD than previously thought. In fact, the study found that COPD patients who weren’t treated with inhaled corticosteroids were more likely to die than those who received the COPD medication.

The Link Between Corticosteroids, Pneumonia, and COPD, and Pneumonia

If corticosteroids carry an increased risk of pneumonia for COPD patients, then how can they also decrease the risk of dying from pneumonia? According to experts, even if inhaled corticosteroids really do increase the risk of pneumonia for those with COPD, it’s very slight.

And some of the older studies that pointed to an increase pneumonia risk in the first place may have had flawed methodology, according to Michael Eichenhorn, MD, the medical director of the department of respiratory therapy at Henry Ford Hospital in Detroit. "There is some uncertainty as to this risk," he says. "In the studies, pneumonia was self-reported and may not have been confirmed by a physician. In addition, pneumonia risk was early in therapy and not throughout therapy — this makes little sense if the pneumonia is truly a side effect of taking the corticosteroid medication."

The Bottom Line on Corticosteroids for COPD

Whether inhaled corticosteroids truly raise the risk of pneumonia for people with COPD and is still up for debate.

But many prominent physicians, including Dr. Eichenhorn, as well as Richard Casaburi, PhD, MD, a professor of medicine at the UCLA School of Medicine, have prescribed corticosteroids to treat COPD despite the pneumonia risk.

"It has been fairly convincingly shown that long-term use of inhaled corticosteroids carries a small increase in pneumonia risk," Dr. Casaburi says. "However, in my view, this is overbalanced by a well-documented, fairly large reduction in COPD exacerbation risk. In my view, in patients with COPD who are experiencing exacerbations, the risk/benefit balance for inhaled corticosteroids is positive."

If you have COPD, it may be worthwhile to ask your doctor if inhaled corticosteroids could play a role in helping you.

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